Unipolar depression in adults: Augmentation of antidepressants with thyroid hormone
- Michael Gitlin, MD
Michael Gitlin, MD
- Professor of Clinical Psychiatry
- Geffen School of Medicine at UCLA
Thyroid hormone can be used in two different ways to treat unipolar major depression. Most commonly, thyroid hormone is used as augmentation for patients who respond insufficiently to antidepressant monotherapy [1-3]. In addition, thyroid hormone can be started simultaneously with a tricyclic at the beginning of pharmacotherapy to accelerate response compared with tricyclic antidepressant monotherapy [4,5]. However, a faster response to treatment does not increase the number of patients who respond by the end of treatment . Thyroid hormone is generally administered as triiodothyronine (T3).
Interest in treating major depression with thyroid hormone initially arose in part because of overlap in the symptoms of major depression and hypothyroidism, including dysphoria, psychomotor retardation, cognitive impairment, fatigue, and weakness [7,8]. Although diminished thyroid function is present in some cases of major depression, adjunctive T3 may be effective for depressed patients who are euthyroid .
The use of thyroid hormone in treating major depression is reviewed here. Treatment resistant depression is discussed separately, as is the initial treatment of depression and treatment of hypothyroidism. (See "Unipolar major depression in adults: Choosing initial treatment" and "Treatment of hypothyroidism" and "Unipolar depression in adults: Treatment of resistant depression".)
Indications for treating nonpsychotic, unipolar major depression with triiodothyronine (T3) include :
●Augmenting response – T3 is added to ongoing antidepressant monotherapy because the patient has not responded adequately; this is the most common indication.
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- GOAL OF TREATMENT
- AUGMENTING RESPONSE TO ONGOING ANTIDEPRESSANT THERAPY
- Evidence of efficacy
- Compared with other adjunctive treatments
- Pretreatment evaluation
- Choice of thyroid hormone
- Dose and administration
- Length of an adequate trial
- Predictors of response
- Safety issues
- - Side effects
- - Laboratory monitoring
- - Drug-drug interactions
- Long-term treatment
- ACCELERATING RESPONSE TO AN ANTIDEPRESSANT
- ENHANCING RESPONSE TO AN ANTIDEPRESSANT